The Clinical Effectiveness of a Brief Consultation and Advisory Approach Compared to Treatment as Usual in Child and Adolescent Mental Health Services

Abstract

A brief consultation and advice (BCA) approach to dealing with routine referrals was introduced into a child and adolescent mental health service (CAMHS) over an 18-month period. This is a time-limited, client-centred and solution-focused approach to dealing with common non-complex referrals. The model proposes that all families are seen for an initial 'consultation' appointment followed by a maximum of two further appointments. A randomized controlled study compared the clinical effectiveness of BCA treatment with treatment as usual (TAU) over a 6-month period. The parents of children referred to CAMHS were eligible to participate if their child was deemed 'non-complex'. Ethical approval was granted by the relevant ethics committee. Families who consented to participate in the study were randomly allocated to either the BCA or TAU group. Sixty children enrolled in the study. Both groups showed improvements on a number of variables at 3 months post treatment, but only those receiving BCA showed continued improvement at 6 months. Participants in both groups showed high levels of satisfaction with the treatment received. Participants in the TAU group expressed dissatisfaction with long waiting times and had a higher drop out rate than the BCA treatment group. During the time frame studied, the introduction of the BCA approach did not lead to a decrease in overall mean waiting time. These results and the usefulness of a BCA model are discussed.

Cost–Utility of Internet-Based Cognitive Behavioral Therapy in Unipolar Depression: A Markov Model Simulation

“…Using simple weighted average remission rates, and thus disregarding treatment lengths, results in higher remission rates both for FCBT of 0.6446 and for ICBT of 0.5802 but alters the incremental values only slightly. Second, the remission rate of CBT depends on several factors, such as waiting time, depression severity, and the number of previous episodes [38,[89][90][91]. Although we modeled waiting time explicitly in our analysis, it played no role in the included studies, which were primarily RCTs designed to measure the efficacy of CBT without any consideration of real-world waiting times.…”

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care

“…First, training approaches for the skills involved with managing patient and family interactions have been well-received and shown to impact child outcomes [ 38 ]. Second, problem- rather than diagnosis-focused approaches to initial mental health treatment [ 39 , 40 ] have helped mental health providers efficiently identify treatable concerns related to the patient and family issues presented in our vignettes, and there is preliminary evidence that they are effective in primary care [ 41 ].…”

Integrating Children’s Mental Health into Primary Care

“…In 2004, Hawaii’s Evidence Based Services Committee pioneered the technique of identifying “practice elements” used repeatedly across multiple evidence-based therapies for specific conditions [39]. Since then, the process of identifying elements has been refined [40] and trials in outpatient child mental health programs have found that using treatment where problems are matched to elements (as opposed to diagnoses being matched to evidence-based interventions) was effective and well-received by families [41,42]. …”